Laserfiche WebLink
r <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> JsmesaCulberiSon. Pres. CNyolLodf <br /> Pslricle E. Vannuccl, Secy. San Joa uln <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 q County <br /> Earl Pimentar5locktan. California 95201 city of E3calon <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Masi. M.D. City of StocktonCity of Tracy <br /> William J. Wade Jog[ Khanna, M.D.. M.P.H.. District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT-INFORMATION,- -. - <br /> I, the undersigned owner and/or operator of the property and/or facility <br /> located at <br /> hereby authorize 6gL-� C �s <br /> to release any and all analytical results, geotechnical data and site <br /> assessment; information to the San Joaquin Local Health District as soon <br /> as it is available and at the same time_ it is provided to me or my <br /> representative. <br /> Owned/Operator: � Titie: <br /> Address ph o. r <br /> Date: <br /> . ��. <br /> t F <br /> EH 08 05 UGT 13 f=:-: C;_ i i U:-, 13 <br />